Aim and Objective: This study aims to determine the effectiveness of laparoscopic appendectomy for children performed as emergency or emergency surgery at MTI/LRH in Peshawar, Pakistan. Material & Methods: From January 2020 to December 2022, the Department of Pediatric Surgery, Medical Teaching Institute, Lady Reading Hospital Peshawar studied acute appendicitis in children. This study comprised children with clinically confirmed acute appendicitis as indicated by blood complete, HBs Ag, HCV, ultrasound, and primary assessment. The pediatric surgical unit maintained direct resuscitation of patients' NPO for at least 6 hours, began antibiotics, and performed laparoscopic surgery under general anesthesia. This strategy avoids additional treatment, saves time and money, reduces hospital-acquired infections and other hospital dangers, and allows for excellent local infection control without pus spreading throughout the peritoneal cavity. Laparoscopic surgery makes cholecystectomy a few-day procedure instead of a week. Laparoscopic appendectomy reduces hospital stays for children. Thus, we examined our data to determine whether children may have an emergency or same-day laparoscopic appendectomy (24-hour postoperative stay). We reviewed all three-year-olds who underwent laparoscopic appendectomy for suspected appendicitis. Results: Acute appendicitis afflicted 79 children, 4/1 male-to-female. 79 2- to 16-year-olds underwent laparoscopic appendectomy surgeries. 5% of children after laparoscopic appendectomy developed perforated appendicitis and needed an open appendectomy. Forty-one (64.5%) had severe appendicitis before surgery. 22 (27.2%) had perforated appendicitis, (5%) had ovarian cyst rupture, and 2.5% had no pathology. Surgery averaged 54 minutes. 14 of 79 primary wound closure patients had their right lower quadrant peritoneal cavity emptied. All 79 patients underwent successful appendectomy operations. Wound infection (6 patients) and stomach pain (4 patients) were the most prevalent sequelae managed conservatively. Four patients required readmission and laparotomy due to intestinal obstruction and other issues. Thirty-two children were released within 24 hours after laparoscopic appendectomy. The control group had no significant morbidity (drug rash,1: fever, 3). Practical implication: This study will provide the data on the effectiveness of the laparoscopic appendectomy for the treatment of Appendicitis. Conclusion: Our study shows that the current laparoscopic appendectomy method for treating adorable appendicitis in children is safe and may be performed as a fast-track or same-day operation with a postoperative stay of fewer than 24 hours in some children who do not have perforated appendicitis. Keywords: Laparoscopic appendectomy, Pediatric Laparoscopy, fast-track same-day surgery

Objective: This study aims to understand more about choledochal cysts and how they are managed in children under 12 years old. Setting and Design: A Descriptive Study at Department of Pediatric surgery L.R.H. Hospital Peshawar. Method and Material: The most common kind of malformation of the biliary tree in Pakistan is choledochal cyst malformation (C.C.M.). Congenital choledochal anomalies range from asymptomatic to life-threatening cholangitis or pancreatitis. Surgeons now recommend total cyst ectomy and bilioentenric anastomosis. This five-year research examines. Clinical presentation, blood and laboratory testing, imaging, surgery, and predictive data were evaluated from case records. Twenty-three children with choledochal cysts were treated between January 2019 and December 2021, and their clinical presentation, diagnostic tests, and treatments were recorded. ERCP or a cholangiogram confirmed choledochal cysts after ultrasound diagnosis (P.O.C.). Before surgery, children with cholangitis received antibiotics and percutaneous transhepatic biliary drainage (excision of the cyst and jejunal loop interposition hepaticoduodenostomy) Results: Twenty-three patients were analyzed; eight presented with chronic abdominal pain, five with a history of cholangitis, two with acute cholangitis, four with biliary peritonitis, and one with a history of pancreatitis. Following cyst excision, Roux-en-Y hepaticojejunostomy (RYHJ) was performed in 13 patients, and hepaticoduodenostomy (H.D.) was performed in 4 patients. One example of congenital choledochal malformation type II was treated with cyst excision and drainage because cholangitis and jaundice threatened the patient's life. The median age was 3, and the gender distribution was about even. Of the patients who sought care, 18 presented with jaundice, 15 with abdominal discomfort, 12 with fever, and 9 with a mass in their stomach. Only four people had all three symptoms of characteristic jaundice, pain, and lump. Overall, the results of both ERCP in 7 patients and P.O.C. in 14 cases were favorable. There were two distinct clinical presentations: I infantile form (less than a year), which included nine infants with jaundice in all, acholic stool in 7, lump abdomen in 4, but only one with classical triad; and (ii) childhood form (more than a year), which included twelve patients with abdominal pain, jaundice, and cholangitis. Twenty patients had a type I cyst, and three had a type Iva cyst. Only two kids said no to surgery, while the rest went through with it. Only three newborns were lost during surgery, but the other 18 did well following their follow-up visits (median 25 months). Six had extrahepatic biliary atresia, two had congenital hepatic fibrosis, and one had congenital biliary cirrhosis. Practical implication: Our study will provide a new data to the health care providers about choledochal cysts and how they are managed in children under 12 years old Conclusions: However, total cyst removal and Roux en Y hepaticojejunostomy (RYHJ) anastomosis is the definitive treatment of Congenital Choledochal Malformation. However, several other temporary therapies are also necessary at various phases of the illness. Their criticality—evolutionary stages may differentiate two types of choledochal cysts from infancy through adulthood. The prognosis is favorable following surgery, but early identification and referral are critical for reducing the risk of complications and mortality. Keywords: Choledochal cyst, ERPC, H.D., RYHJ, and C.C.M. (Endoscopic retrograde cholangiopancreatography)

Aim and Objective: to understand the outcomes of treating pediatric rectal prolapse with injection sclerotherapy using 5% phenol in almond oil. Setting & Design: Department of Pediatric Surgery MTI / LRH, Peshawar, Pakistan. A- Descriptive Study the duration of study from June 2021 to June 2022 Material & Method: In Pediatric Surgery, rectal prolapse is a prevalent issue with various potential solutions. Injection sclerotherapy was one of the techniques studied in this analysis of treatments for children with rectal prolapse. Patients who have had complete prolapse for more than three months were considered. Patients were checked in 24 hours before surgery. Before the procedure began, a Kleen Enema was administered. This operation was done while the patient was under general anesthesia. Sclerotherapy was performed by injecting a solution of 5% phenol in almond oil. While the patient was unconscious, an injection was placed in the rectum's submucosa. 8-10mL of a 5% phenol in almond oil solution was injected at 3-4 linear locations. Every patient was monitored for a whole month to look for signs of recurrence. Results: A total of 42 individuals were seen. There were 32 men and ten women among the total number of patients. Children as young as two years old and as elderly as eight years old were involved. A prolapse might endure between three months to four years. For 26 people, chronic diarrhea was a recognized problem. Sclerotherapy injections were administered to a total of 26 patients. There were no issues from the anesthesia or the procedure itself. There was no evidence of a recurrence during the one-month follow-up. Practical implication: This study will review our experience with the treatment of rectal prolapse in children and to formulate a management strategy based on outcome. Conclusions: Rectal prolapse may be successfully treated securely, affordably, and efficiently with injectable therapy using 5% phenol and almond oil. Keywords: Recto Prolapse, Sclerotherapy, children, injectable therapy, Sclerotherapy

Objective: This study aimed to evaluate the functional result of pediatric patients at MTI / LRH, Peshawar, who had Posterior Sagittal Anorectoplasty (PSARP) for anorectal abnormalities. Methods: Three hundred and fifty cases with anorectal anomalies were analyzed in this research from 2017 to 2021 at MTI/Lady Reading Hospital Peshawar. Except for female patients with rectogenital tract fistula, distal logograms were regularly done on all patients. Each patient diagnosed with an intermediate, high-type, or cloacal malformation underwent PSARP. Both intraoperative and postoperative mortality and morbidity rates were documented. Following the PSARP treatment, patients should continue to have their anesthetics dilated regularly for three to six months after discharge. Six months to a year of patient follow-up was conducted. Results: Three hundred and fifty patients (12–36 months of age) participated in the study (245 males and 110 girls). All patients had PSARP done. One hundred ninety-five males were diagnosed with a rectourethral fistula, 95 girls with a genitourinary tract fistula, and five girls with a cloacal malformation. There was a 2.5% death rate (9/35 operations) from the surgery and its aftermath. At the outset of treatment, 30% of patients had excellent outcomes, 45% experienced fair results, and 25% experienced poor outcomes. Ninety-nine individuals had chronic constipation, and 35 had anal stenosis. Sixty individuals had mucosal prolapse and perineal irritation. In 5 patients, recurrent UTIs occurred, and in 3 cases, orchitis. The urethral stricture was discovered in two patients, and a urethral diverticulum was identified, necessitating revision surgery. Practical implication: The recorded data outcomes will be useful for the surgeons in the same setting. Conclusion: Most severe and mild anorectal abnormalities were seen in male infants. Regarding bowel control, PSARP surgery is a safe option with positive functional outcomes. Keywords: Anorectal Malformation, Anomalies, Posterior Sagittal Anorectoplasty, Pull Through, Faecal Continence, Constipation.

Objectives 1 To investigate the effectiveness of ultrasound guidance in pediatric surgical procedures. 2 To compare the surgery duration and success rate between the group with ultrasound guidance and those without it. 3 To assess the potential complications associated with ultrasound guidance for pediatric surgery. 4 To discuss the importance of ultrasound guidance in pediatric surgical procedures. Methods: This prospective interventional study was conducted in the Department of Pediatric Surgery, Lady Reading Hospital (LRH), Peshawar, Pakistan, from January 2021 to January 2022. The study's sample size included sixty patients between the ages of one to fifteen years, who were divided into two groups of thirty. In the first group, the patients underwent an ultrasound examination before the surgical procedure, while in the second group, the patients did not undergo an ultrasound examination. After the surgical procedure, the duration of surgery was recorded and observed for comparison between the two groups. The success rate of the course was also honoured concerning each group. Statistical analysis was done by SPSS version 22.0, and the P-value was set to < 0.05 for the significance test. Results: The study results reveal that ultrasound guidance was significantly practical (p-value < 0.05) in reducing the surgery duration by an average of 10 minutes compared to the group without ultrasound guidance. Moreover, the procedure's success rate was also significantly improved (p-value < 0.001) in the ultrasound-guided group, with no significant complications. Conclusion: The present study concluded that ultrasound guidance effectively reduces the surgery duration and improves the success rate of pediatric surgical procedures. The study also highlighted the importance of this advanced imaging technique in pediatric surgery. The study recommends that ultrasound guidance be used routinely for pediatric surgeries to obtain accurate results and minimize potential risks. Keywords: Ultrasound Guidance, Pediatric Surgery, Surgery Duration, Success Rate, Complications.